完全胸腔鏡下に摘出した縦隔発生硝子血管型Castleman病の1例

A case of hyaline-vascular-type Castleman's disease resected by complete thoracoscopic surgery

◆要旨：縦隔に発生するCastleman病は他の縦隔腫瘍との鑑別が困難であり，外科的摘出されることが多い．切除例の報告では多くが易出血性であり注意が必要である．患者は18歳女性で，胸部CTにて気管右側から前方に4.0×2.5cmの腫瘤影を認め，3D-CTにて腫瘤と大動脈〜右鎖骨下動脈の間に異常血管を認めた．異常血管をクリップし，完全胸腔鏡下に腫瘤を摘出しえた．病理組織学的に硝子血管型Castlman病と診断した．1983〜2018年までの期間で医学中央雑誌およびPubMedにて検索しえた範囲では，縦隔・肺門に発生し，摘出術を施行した症例は119例報告されていた．Castleman病の腫瘤は異常血管を伴い血流が豊富であることが多く，特に胸腔鏡下手術においては慎重な術前評価と出血対策が必要である．

　Unicentric Castleman's disease is difficult to distinguish from neoplasms at the mediastinum; thus, unicentric Castleman's disease is often treated via resection. However, the hypervascularity of Castleman's disease should be considered when surgical treatment is chosen. We experienced a case of hyaline-vascular-type Castleman's disease treated by complete thoracoscopic surgery. Herein, we present this case and a review of the cases involving resections in Castleman's disease. An 18-year-old woman showed an abnormal shadow on chest radiography during a health examination in her college. Preoperative computed tomography revealed a 4.0 × 2.5cm mass on the right side of the trachea. Three-dimensional-computed tomography clarified localization of abnormal vessels around the mass. The mass was resected with complete thoracoscopic surgery and diagnosed as hyaline-vascular-type Castleman's disease. Six years after the surgery, no recurrence was observed. We reviewed the literature on cases involving resections for mediastinal and hilar Castleman's disease within the period of 1983-2018 from the Japan Medical Abstracts Society database and PubMed.